NPIMap

Organization Active NPI

Cowlitz Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Woodland, WA
National Provider Identifier
1053472993
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COWLITZ FAMILY HEALTH CENTER
Practice address
1251 Lewis River Rd Ste D
Woodland, WA 98674-9203
Phone
(360) 225-4310
Fax
(360) 225-4339
NPI assigned
Dec 13, 2006
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COWLITZ FAMILY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Coffee
Title
Ceo
Phone
(360) 636-3892

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X WA
Non-Surgical Family Planning Clinic/Center 261QF0050X WA
Federally Qualified Health Center (FQHC) 261QF0400X WA Primary
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

1251 Lewis River Rd Ste D
Woodland, WA 98674-9203

Mailing address

1057 12TH Ave
Longview, WA 98632-2509
Phone (360) 636-3892

Other identifiers 3

IdentifierTypeStateIssuer
7900426MedicaidWA
7086523MedicaidWA
7407349MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040324000330 WA Part B Supplier - Clinic/Group Practice 5991696395 Receives reassigned benefits from 19 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Castle Rock, WA; Cathlamet, WA; Kelso, WA; Longview, WA; Ocean Park, WA; Woodland, WA
O20040825000373 WA Part A Provider - Federally Qualified Health Center (FQHC) 5991696395 1 other NPI on this enrollment
Practice locations: Woodland, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053472993. Details of each certification follow.

Federally qualified health center certification: CCN 501884

Legal name
COWLITZ FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2004
Last certification
Oct 1, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1973 in WA
Enrollment address
1251 Lewis River Rd D
Woodland, WA 98674-9203
Related CCNs
501852

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
NB North Beach Clinic14 organizations share this tax ID, including this one
Part of
NB North Beach Clinic

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

784 14th Ave
Longview, WA 98632
Phone (360) 425-6117

1251 Lewis River Rd
Ste C
Woodland, WA 98674
Phone (360) 703-6401

1251 Lewis River Rd
Ste D
Woodland, WA 98674
Phone (360) 225-4310

Networks

  • devoted network organization-54bc88f0-8c1c-41b6-b022-755ebfe4d22c

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Wanda M McBee Individual Corporate OfficerBoard Secretary Aug 1, 2006
Deborah Idlett Nelson Individual Corporate DirectorBoard Member Aug 4, 2020
Ryleigh Leatherwood Individual Corporate DirectorBoard Member Feb 2, 2022
James Coffee Individual W-2 Managing EmployeeCeo Dec 1, 2020 100%
Operational/Managerial ControlCeo Dec 1, 2020 100%
Leah McElyea Individual Corporate DirectorBoard Member Dec 1, 2021
Cynthia L Washington-Mattson Individual Corporate OfficerBoard Vice President Jun 1, 1994
Quincey Shinnick Individual Corporate DirectorBoard Member Mar 24, 2020
Mark Nelson Individual Corporate OfficerBoard President Dec 4, 2019
Okal Denise Oldroyd Individual Corporate DirectorBoard Member Dec 1, 2021
Mark Gaither Individual Corporate DirectorBoard Member May 2, 2018

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1053472993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-636-3892",
            "fax_number": "360-414-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 LEWIS RIVER RD STE D",
            "city": "WOODLAND",
            "state": "WA",
            "postal_code": "986749203",
            "telephone_number": "360-225-4310",
            "fax_number": "360-225-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ FAMILY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COWLITZ FAMILY HEALTH CENTER",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "COFFEE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-636-3892"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7900426",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7086523",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7407349",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland, WA

Sources for this page

Verify at the official NPI Registry.